Health system challenges in the diagnostic and treatment pathway for patients with suspected cervical cancer: a qualitative study

The burden of cervical cancer (CC) is rising in Ethiopia, yet delays in diagnosis and treatment along care pathways remain a challenge. We aimed to explore the health system challenges affecting timely diagnosis and treatment of suspected CC in Ethiopia. We carried out a qualitative study in six hospitals in Oromia and Central Ethiopia. We conducted ten in-depth interviews and six focus group discussions with 26 health providers involved in CC care, three policy makers (one from the Ministry of Health and two from Regional Health Bureau) engaged in cancer control, and seven patients with suspected CC. We used the ATLAS.ti.25 software for data analysis. The participants highlighted health system challenges within health facilities affecting the timely diagnosis and treatment of suspected CC. Support systems and coordination within the health system play a critical role in shaping the care pathway from diagnosis to treatment. The diagnosis to treatment pathway for suspected CC is constrained by limited provider experiences and by loop electrosurgical excision procedure related capacity and referral bottlenecks. We also identified several challenges along the care journey that impact the transition from diagnosis to treatment, including decisions regarding treatment options, the unavailability of biopsy equipment driving patients toward high-cost private alternatives, the accessibility of services, health providers’ skills, patients’ income levels, and the quality of communication. Timely diagnosis and treatment of suspected CC are hindered by several health system challenges. The unavailability of biopsy equipment, forcing patients into costly private care, is a major structural barrier to timely diagnosis. Socioeconomic barriers, provider skills, and weak communication further delay care. Addressing these systemic and structural issues is essential to improve the continuum of care for women with suspected CC, ultimately enhancing outcomes and reducing preventable mortality.